Maharashtra: Demand shoots up, black fungus drug new hurdle

Maharashtra's monthly requirement for the drug has grown 100 times, from 3,000 during pre-pandemic days to three lakh injections, as of now. Pharmaceutical companies seem to be incapable of servicing this increased demand.

Each day, Dwarkadas Wadhwa (64) spends at Mumbai’s PD Hinduja Hospital fighting off mucormycosis, the fungal infection brings forth a new set of challenges for his family.

“Whatever injections we could get will be used today, for tomorrow we have nothing,” said his daughter Kusum Sachdeva. Her father’s infection has slowly crept up his nose and is spreading towards his eyes in spite of two surgeries to cut it out.

Wadhwa is one of 1,500 patients suffering from Covid-associated mucormycosis or black fungus, in Maharashtra. While 90 have died so far, the extremely costly and rare antifungal medicine, liposomal amphotericin B injection, has emerged as a lifesaver. The procurement of the drug, however, has been a massive challenge for many like Wadhwa, who require anything between 90 and 120 vials that cost anything between Rs 6,000 and Rs 8,000 each.

Maharashtra’s monthly requirement for the drug has grown 100 times, from 3,000 during pre-pandemic days to three lakh injections, as of now. Pharmaceutical companies seem to be incapable of servicing this increased demand.

While the Wadhwa family can afford the injection, they are unable to source it. Several, like 29-year-old Samiya Mushtaq’s family, have run out of their savings to buy this drug. “After being infected with Covid, she was diagnosed with mucormycosis. We spent Rs 4 lakh on the injections to treat the infection at a private hospital, but have run out of money now,” said mother Sabiha.

Like remdesivir, the state government has asked all collectors to control the supply of amphotericin B to hospitals to prevent black marketing and hoarding. D R Gahane, joint commissioner (drug) in Food and Drug Administration, said the state required 3 lakh injections a month, but could procure only 8,500 last week while the BMC procured another 1,000. The Centre allotted only 16,500 injections as Maharashtra’s quota, he said.

State Health Minister Rajesh Tope has urged the Centre to increase the allocation and allow manufacturers to sell directly to the state, which has placed an order for 1.90 lakh amphotericin injections but is yet to get the supply.

Bharat Serum, BDR Pharmaceuticals, Cipla and Mylan are major manufacturers of amphotericin B injection. But its production is hampered by shortage in active pharmaceutical ingredients (API).

Manufacturers are scouting for more options to buy API. Some have reached out to North China Pharmaceutical Group (NCPC) in China. “They assured us 40-50 kg by the end of June. We have also approached DCGI (Drugs Controller General of India) to approve another Chinese company to supply amphotericin. It has US FDA, but is yet to get approved in India,” said BDR Pharmaceuticals chairperson and MD Dharmesh Shah.

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